title: 'Septrin psychosis' among renal transplant patients with Pneumocystis jirovecii pneumonia.
abstract: OBJECTIVE
  To report on the temporal relationship between administration of trimethoprim/sulfamethoxazole to medically immunosuppressed HIV-negative renal patients with Pneumocystis jirovecii pneumonia (PCP) and the development of an acute psychosis.
  
  
  METHODS
  We investigated a retrospective case series of renal transplant and immunosuppressed patients with PCP within an ongoing outbreak in the northwest of England since 2009. Four patients with PCP developed psychosis following treatment with trimethoprim/sulfamethoxazole.
  
  
  RESULTS
  Four of twenty patients developed acute psychoses following administration of trimethoprim/sulfamethoxazole, including one accidental re-challenge. Symptoms resolved within 24 h of changing the therapy. The striking temporal relationship between the initiation and discontinuation of the drug and the behavioural changes suggests a causal relationship.
  
  
  CONCLUSIONS
  With increasing solid organ transplantation and the use of immunosuppressants, vigilance regarding trimethoprim/sulfamethoxazole dose modification is required and the routine use of therapeutic drug monitoring should be considered.
authors.affiliation: Department of Clinical Pharmacology and Therapeutics, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Walker
authors.forename: Sherine
authors.initials: S
authors.lastname: Thomas
authors.forename: Catherine
authors.initials: C
authors.lastname: McBride
authors.forename: Matthew
authors.initials: M
authors.lastname: Howse
authors.forename: Lance C W
authors.initials: LC
authors.lastname: Turtle
authors.forename: Roberto
authors.initials: R
authors.lastname: Vivancos
authors.forename: Nick J
authors.initials: NJ
authors.lastname: Beeching
authors.forename: Michael B J
authors.initials: MB
authors.lastname: Beadsworth
mesh_terms: D000328:Adult; D000368:Aged; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced*; D008875:Middle Aged; D045363:Pneumocystis carinii / Q000187:drug effects; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy* / Q000453:epidemiology*; D012189:Retrospective Studies; D014180:Transplantation; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage* / Q000009:adverse effects*
chemical_list: D015662:Trimethoprim, Sulfamethoxazole Drug Combination